Wisdom Teeth Extraction In-Depth

Your wisdom teeth are the last of your adult teeth to erupt. While all of your other adult teeth erupt by around the age of 13, the wisdom teeth do not come in until your late teens to early 20s. For some adults, the wisdom teeth come in just like any other teeth, causing no issues. However, for many individuals, the wisdom teeth become impacted and cause issues that can cause significant pain and oral health complications. If your wisdom teeth are impacted, Lehigh Oral and Maxillofacial Surgery can help with wisdom teeth extraction.

History of the Wisdom Teeth

Long ago, the wisdom teeth had a very important job. The third molars were played a crucial role in helping our ancestors to chew and break down a wide array of course foods that made up the human diet before the invention of cooking. The human jaw at this time was also larger, so the wisdom teeth had plenty of space to grow.

The invention of cooking changed things. Humans no longer had to work hard to break down the foods they ate. Cooking softened many foods, making chewing significantly easier. Over time, the human jaw began to shrink, and the wisdom teeth became obsolete. Today, just like the appendix, they are classified as vestigial. They still develop, but they serve no functional purpose.

How Wisdom Teeth Grow

The eruption of the wisdom teeth also called the third molars, is quite slow. Between the ages of 8 and 10, shadows of the wisdom teeth are visible on X-ray images. The crowns of the wisdom teeth form around the age of 12, and the roots develop around the ages of 17 and 18. The teeth then erupt in the late teens to early 20s.

What Causes Impacted Wisdom Teeth?

An impacted tooth is one that cannot erupt completely through the gums. These are called partially impacted teeth. Teeth that cannot erupt through the gums at all are called fully impacted teeth. Any tooth in your mouth can become impacted. The wisdom teeth, however, are the most likely to be affected by this issue. There are a few different reasons why the wisdom teeth might become impacted.

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The jaw is not large enough. For many people, the wisdom teeth become impacted simply because there is not enough space in the jaw to accommodate them.

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The teeth are growing at an angle. They may be angled toward the back of the mouth or angled toward the second molars. They may also be lying down in the jaw.

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The teeth may be blocked from erupting properly. Blockages could be hard tissue or soft tissue.

When Should Wisdom Teeth Be Removed?

Typically, an exam is done around the age of 15 or 16 to determine the direction in which the wisdom teeth are growing. Because the roots are not fully formed at this age, if the wisdom teeth are predicted to become impacted, extraction of the wisdom teeth can be simplified. The best age to remove wisdom teeth is between 16 and 20. During this time, the roots are short and only partially formed. The bone around the wisdom teeth is softer, and the tooth has a larger amount of soft tissue around it. These factors contribute to an easier healing process. The older you are before removing impacted wisdom teeth, the longer the roots are and the harder the bone is. These factors make extraction more complex.

Reasons Why Impacted Wisdom Teeth Need to Be Extracted

There are a few different reasons why impacted wisdom teeth might need to be removed. These reasons include:

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Pericornitis. Pericornitis is an issue that commonly affects partially erupted wisdom teeth. These areas of the mouth can be difficult to keep clean. If plaque and bacteria are left to accumulate on partially erupted teeth, it can lead to gum inflammation surrounding them. This is known as a localized infection, or pericornitis.

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Cavities and pulpitis. Again, partially erupted wisdom teeth are difficult to keep clean, which can lead to an accumulation of plaque and bacteria. The acids produced by these substances can erode the enamel of the wisdom teeth, leading to the formation of cavities. Untreated cavities can lead to pulpitis or the inflammation of the pulp inside the tooth. Bacteria inside the tooth can eventually reach the root which can lead to a root infection. Tooth root infections are a common reason why teeth, including wisdom teeth, need to be extracted.

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Cysts. Wisdom teeth develop in sacs within in the jawbone. These sacs can sometimes fill with fluid, which leads to a cyst. Cysts can also sometimes form as a result of an infection. No matter how they form, cysts can cause damage to the jawbone, teeth, and the nerves. The longer they go without treatment, the larger they become and can lead to the need for a bone graft to restore destroyed bone mass. In rare occasions, a benign, or non-cancerous, tumors may form. In many cases, removing a tumor also requires the removal of some bone and soft tissue.

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Damage to adjacent teeth. Wisdom teeth growing at an angle, especially if they are growing toward the second molars, pose a significant risk of tooth damage. As the wisdom teeth grow, they can push up against the second molars, which can lead to chips and fractures. This damage can lead to infections in the second molars, which could then lead to the need for a root canal. If the damage occurs entirely below the gum line and an infection occurs, the second molars may require extraction as well.

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Overcrowding. Even if the wisdom teeth are growing straight up, they can still pose complications. If there simply is not enough room in your jaw to accommodate all 32 teeth, the wisdom teeth could force the second molars out of proper alignment. This pressure continues to the rest of your teeth, forcing all of them out of alignment as causing your smile to become overcrowded.

Symptoms of Impacted Wisdom Teeth

There are several symptoms that can point toward impacted wisdom teeth. Symptoms include:

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Severe pain at the back of your mouth. One of the most common symptoms of impacted wisdom teeth is a throbbing pain at the back of the mouth. You may notice the pain radiating from the back of the mouth where the wisdom teeth are located. Pain tends to get worse as the situation progresses and other teeth become affected.

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Swollen gums. When your wisdom teeth are impacted, they can cause significant issues for your gums. The tissue near the wisdom teeth can become swollen and tender to the touch. They may also bleed when pressure is applied. While this symptom could point toward impacted wisdom teeth, it could also indicate gum disease, so it is important to seek dental treatment immediately.

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Swelling of your jaw. Impacted wisdom teeth can also cause the jawbone to swell. It may not seem serious at first, but it can worsen over time, making it difficult to open and close your mouth.

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Headaches. Pain from the wisdom teeth can radiate, which can then lead to headaches and other facial pain.

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Swollen glands. Impacted wisdom teeth can also lead to swollen glands in the neck and shoulder.

Diagnosing Impacted Wisdom Teeth

An exam is typically performed around the age of 15 or 16 to predict the growth trajectory of the wisdom teeth. Usually, this exam, regardless of whether or not you are exhibiting symptoms, can help to determine the need for a wisdom tooth extraction. Sometimes the potential for impacted wisdom teeth is missed. As your wisdom teeth attempt to grow, you then begin to exhibit symptoms.

At the first signs of impacted wisdom teeth, it is important to schedule an exam immediately. Dental X-rays allow us to determine the positioning of your wisdom teeth as well as any other potential complications, such as cysts or adjacent tooth damage. After diagnosing impacted wisdom teeth, a treatment plan is made, and you are scheduled for surgery.

Extracting Impacted Wisdom Teeth

The process of extracting wisdom teeth is not painful. Some patients may be able to undergo the procedure using only a local anesthetic, while others may require sedation or even general anesthesia. With a local anesthetic, you are completely awake for the procedure, and all you feel is pressure. Sedation options vary. You may be conscious, but you are made to feel completely relaxed and comfortable. Sedation can be a great option for patients who are feeling anxious or afraid.

When you are relaxed, your anxiety is reduced, and the procedure can be performed in a safe, effective manner. With general anesthesia, you are made to sleep throughout the entire procedure. This can be a great option for patients who require a very complex procedure or if you are feeling incredibly anxious or fearful.

After you have received your local anesthetic and sedation, surgery begins. We start with small incisions in your gums to expose the roots of the wisdom teeth and the surrounding bone. We work to remove the teeth from their sockets as gently as possible. For some, this is as simple as loosening the periodontal ligaments surrounding the teeth and essentially popping them out.

For others, the teeth may need to be sectioned and removed in pieces. If a cyst or tumor is present, these are also removed. Once the teeth have been removed, a couple of small stitches are placed. There is generally a short rest period before you are released to go home. Depending upon the type of sedation you receive, you may need to have someone to drive you home.

Recovering After Extraction

Before you leave the office, you are provided with specific aftercare instructions. These instructions help you to deal with common post-surgical issues and help you to avoid infections. While recovery after a wisdom tooth extraction generally only lasts a few days, following your instructions is crucial to avoiding complications.

Pain and swelling are some of the most common post-surgical issues. Pain can often be managed with an over the counter pain reliever. You may also be provided with a prescription for a stronger medication if necessary. Swelling can be dealt with using an ice pack on and off for 20 minutes at a time during the first 24 hours. After 48 hours, most heat can be applied on and off for 15-minute intervals to help the swelling go down faster.

You will need to alter your eating habits while you heal. It is important that you do not eat anything until your local anesthetic wears off. This will help you to avoid biting your cheek or tongue. It is highly recommended that you stick to soft foods for a few days. You may even want to stick to mainly liquids during the first 24 hours. A soft foods diet, consisting of foods such as smoothies, yogurt, and mashed sweet potatoes, will help to avoid pain while you eat. It will also help to avoid irritating the surgical sites. It is important that you do not skip meals and eat nutritious foods. Good nutrition will help to ensure that your surgical sites get the nutrients they need to heal properly. As you begin to feel more normal, you can gradually resume your normal diet.

It is also recommended that you limit your activities during the recovery process, avoiding anything strenuous. During the first 24 hours, you should plan on simply resting with your head elevated. Avoid heavy lifting, bending over, or exerting yourself too hard. Doing any of these things could lead to bleeding and exacerbate pain and swelling.

Finally, taking care of your mouth is essential for helping to avoid infections and other complications. Continue to brush and floss your teeth but take care when brushing near surgical sites. A salt water rinse can be used during the course of the day to help rinse out your mouth and kill bacteria.

One of the most common issues following wisdom tooth extraction is a condition called dry socket. This is a condition in which the clot becomes dislodged from the surgical wound. This can be caused by a sucking motion, which is often the result of drinking through a straw or smoking. Stay hydrated, but drink from the glass rather than using a straw.

It is also important that you avoid smoking during your recovery process. Not only can smoking cause dry socket, but it can also slow your recovery and increase your risk for other complications. Taking good care of your mouth and following your aftercare instructions will help you to avoid issues. Should a complication arise, however, call the office right away.

Impacted wisdom teeth can be problematic, but extraction can help to eliminate pain and restore the health of your mouth. For more information on impacted wisdom teeth and to schedule your consultation, call Lehigh Oral and Maxillofacial Surgery today at (610) 435-6161.